• J Stroke Cerebrovasc Dis · Nov 2013

    Treatment of acute stroke in patients on dabigatran: a survey of US stroke specialists.

    • Igor Rybinnik, Michael T Mullen, Steven Messe, Scott E Kasner, and Brett Cucchiara.
    • Department of Neurology at North Shore University Health System, Manhasset, NY.
    • J Stroke Cerebrovasc Dis. 2013 Nov 1;22(8):1312-6.

    BackgroundThere are no guidelines for thrombolysis in stroke patients taking dabigatran, or dabigatran reversal strategies in patients with ICH. We sought to assess how vascular neurologists plan to care for these patients.MethodsAn Internet-based questionnaire was sent to US board-certified vascular neurologists. Case scenarios for patients on dabigatran with acute ischemic stroke or ICH were presented; questions assessed preferred treatment strategies.ResultsIn all, 221 vascular neurologists responded. For a typical ischemic stroke patient eligible for intravenous (IV) tissue plasminogen activator (tPA) except for use of dabigatran (time of last dose unknown), 49% would not treat with tPA regardless of PTT, 28% would treat if PTT was normal, 9% would treat if PTT was less than 40 seconds, and 4% would treat regardless of PTT. Even more variability in responses was seen when presented with a normal PTT but variable times from last dabigatran dose. Between 8%-14% of respondents were not sure what they would do. For catheter-based thrombolysis, 25% indicated they would treat with IV tPA but would prefer catheter thrombolysis, 30% would use IV tPA and consider catheter thrombolysis as for any patient, 36% would only use catheter thrombolysis, and 9% would not use IV tPA or catheter thrombolysis. For a patient with dabigatran-associated ICH, 73% said they would attempt reversal of dabigatran with the following modalities: FFP 53%; factor VIIa 24%; prothrombin complex concentrates 61%; platelet transfusion 7%; and hemodialysis 24%.ConclusionsThere is a remarkable lack of consensus among vascular neurologists regarding the assessment and treatment of acute stroke patients on dabigatran.Copyright © 2013 National Stroke Association. Published by Elsevier Inc. All rights reserved.

      Pubmed     Full text   Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…